MEDICARE: SONYA MARIE GONZALES L.C.S.W

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	53752	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992142368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SONYA MARIE GONZALES L.C.S.W

Provider Business Mailing Address
First Line	:	2010 NORTH LOOP W STE 115
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-8131
Country	:	US
Telephone Number	:	832-285-3911
Fax Number	:	855-279-3152

Provider Business Practice Location Address
First Line	:	2010 NORTH LOOP W STE 115
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-8131
Country	:	US
Telephone Number	:	832-285-3911
Fax Number	:	832-553-2546

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2013
Last Update Date	:	12/28/2023

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